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TRAINEE-LED SURGICAL RESEARCH COLLABORATIVES Dan Beral Collaborate • Verb • 1. to work, one with another; cooperate. • 2. to cooperate, usually willingly, with an enemy nation, especially with an enemy occupying one’s country. The problem with research.. • Difficult to conduct research on an individual basis during a single post • Network formed by registrars rotating through the region • Can be exploited to run multicentre trials • A multitude of benefits Project Methodology & design Data Collection Team leading & analysis & working Write papers Patients Enhance CV Trainee Publications Multicentre & Presentations Benefits of Trials Research Transferable Collaborative skills Quality of Research More clinical Region Better surgical trials recruitment The West Midlands Experience WMRC • Set up by surgical registrars • Supported by Professor Dion Morton • Links with University of Birmingham Clinical Trials Unit WMRC Studies • ROCSS • DREAMS • Pancreatitis Study • ROSSINI • CANOES • CANOES II • CHARMS ROSSINI • Reduction Of Surgical Site Infection using a Novel Intervention • Prospective, multicentre, observer-blinded RCT using wound-edge protectors • Over 500 patients recruited • NIHR RfPB support DREAMS • Dexamethasone Reduces Emesis After Major gastrointestinal Surgery • Funded by Bowel Disease Research Foundation grant • NIHR Portfolio trial • Phase III double-blind, multicentre RCT ROCSS • Reinforcement Of Closure of Stoma Site • Prospective, multicentre, double-blind RCT mesh (Strattice) vs standard closure • Pilot complete, recruiting beginning Pancreatitis Study • Retrospective, multicentre audit of timing of cholecystectomy after gallstone pancreatitis • Effect on morbidity, readmissions and operative complications CANOES I/II • Cancer Outcomes Ethnicity Study I • Retrospective, multicentre study comparing breast cancer outcomes of ethnic minority patients vs white patients • Cancer Outcomes Ethnicity Study II • Looking at variations in adjuvant therapies received between ethnic minorities with breast cancer • Abstracts: EJSO, BJS and Cancer Research • Presentations: San Antonio, BASO, SARS CHARMS • Clostridium difficile in Hospitals – A Regional Multicentre Study • Retrospective analysis of prospectively collected data – over 7000 patients identified • Analyse whether elective colorectal patients have enhanced susceptibility to C. diff. • Control for bowel prep, antibiotic use and infection control measures used SWIFT • Shift Work Impact on Foundation Training • Assessment of FY1 knowledge of their acute general surgery patients • Whether any weaknesses are related to having clerked/presented the patient So that’s a good idea then… SPARCS Others MeRGS YSRC LSRG STORC WMRC CERRG WBRG The Yorkshire Surgical Research Collaborative • Founded June 2011 • Mentor: Professor David Jayne • Executive Committee: • Chairman: Dan Beral • Secretary: Gareth Hicks • Treasurer: Deena ElSharief • New Projects Coordinator: Soroush Sohrabi • Communications Secretary: Tak Khong YSRC Projects • Many new ideas presented including: • Surgical Admissions Unit Audit • PancreatitYS Study • Prucalopride study • Pulse Wave Velocity Studies • Breast Audits SAU Audit • Audit of SAU admissions across Yorkshire • Data collection and pattern analysis • Generation of future research avenues • Pilot to take place in Leeds next month PancreatitYS • Pancreatitis – The Yorkshire Study • Little is known about precise relationship of EtOH to alcoholic pancreatitis – dose/type • Some epidemiological evidence to suggest spirits are major cause Pulse Wave Velocity Studies • Prognostic value of PWV and serum Troponin measurement in prediction of mortality and cardiovascular events in patients with Critical Limb Ischaemia pre and post intervention • Prognostic value of PWV and ABPI measurements in small and large bowel anastomotic leaks • Audit being analysed prior to ethics, piloting and funding application www.ysrc.org.uk The future of collaboratives? • Progress by individual collaboratives • Publishing of large, multicentre RCTs • Inter-collaborative collaboration • National Collaborative Research Register • All trainees will one day be members? International appendicectomy audit • Appendicitis still remains controversial: • Diagnostic challenge despite modern radiology • Persistent negative appendicectomy rate • High wound infection rates • High intra-abdominal collection rates • Laparoscopic vs open? International appendicectomy audit • Negative appendicectomy rate • Overall negative appendicectomy rate of <20%; 5 to 15% in males and 10 to 30% in females5-7. • Rates of wound infection requiring readmission • Wound infection rate of <10%. The highest level of evidence arises from a Cochrane review which pooled data from 50 randomised trials to find an overall wound infection rate of 5.4% (321/5972)4. The inter-quartile range for rates from individual studies was 2.5% to 7.6%. International appendicectomy audit • Intra-abdominal abscess rate • Intra-abdominal abscess rate of <2.5%. The highest level of evidence arises from a Cochrane review which pooled data from 45 randomised trials to find an overall intra-abdominal abscess rate of 1.4% (78/5577)4. The inter-quartile range for rates from individual studies was 0% to 2.3%. • Provision of laparoscopic appendicectomy • Routine use of laparoscopy. Guidelines from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) recommend routine use of laparoscopy unless contra-indicated11. The impact of laparoscopy on the main outcome measures will be assessed. The highest level of evidence arises from a Cochrane review of 57 randomised trials, which showed that LA was associated with fewer wound infection (OR 0.43; CI 0.34 to 0.54), more intra-abdominal abscesses (OR 1.87; CI 1.19 to 2.93) and a marginal increase in duration of surgery (10 minutes [CI 6 to 15])4. International appendicectomy audit • 1000 patients • 1st May – 30 June • 30 day follow up What can I do? • Trainees: • Join in! • Come to the meetings • Take part in studies • Get published • Write your CV and get on in your career! What can I do? • Consultants: • Support your trainees • Encourage ideas and participation • Allow your patients to participate in collaborative studies • Use the collaboratives to get your own projects done! Thank you • Any questions?
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